Effects of whole-body vibration applied to lower extremity muscles during decline bench press exercise.

OBJECTIVES: To evaluate the effects of whole-body vibration (WBV) on skeletal muscle activity and power performance of the upper body during decline bench press exercise at different loads. METHODS: Forty-seven healthy young and active male students volunteered. Each performed dynamic decline bench press repetitions with and without WBV (50 Hz, 2.2 mm) applied through a hamstring bridge exercise at three different loads of their 1-repetition maximum (1RM): 30%, 50%, and 70% 1RM. Muscle activity of the triceps brachii (TB), biceps brachii (BB), pectoralis major (PM), and biceps femoris (BF) was measured with surface electromyography electrodes and kinetic parameters of the repetitions were measured with a rotary encoder. RESULTS: WBV increased peak power (PP) output during the 70% 1RM condition (p<0.01). Muscle activity was increased with WBV in the TB and BF muscles at all loads (p<0.05). There were no effects of WBV on BB or PM muscles. CONCLUSION: WBV applied through a hamstring bridge exercise increases TB muscle activity during a decline bench press and this augmentation contributes to an increased peak power at higher loads and increased peak acceleration at lower loads.

Comprehensive analysis of venom from the scorpion Centruroides tecomanus reveals compounds with antimicrobial, cytotoxic, and insecticidal activities.

Centruroides tecomanus is a medically important scorpion of the state of Colima (Mexico). This communication reports the identification of venom components of this scorpion with biological activity over insects/crickets (Acheta domestica), crustaceans/fresh water shrimps (Cambarellus montezumae), and mammalians/mice (Mus musculus, strain CD1). It also describes the pharmacological effects on cell lines in culture (L5178Y cells, HeLa cells, HuTu cells and Jurkat E6-1 cells), as well as on several types of bacteria (see below). The soluble venom of this scorpion was fractionated by high-performance liquid chromatography (HPLC) and collected separately in twelve independent fractions collected over 60 min run (5 min time apart each other). The HPLC components of fraction VII were lethal to all three species used for assay. The IVth fraction had a toxic effect on freshwater shrimps. In this species, fractions VI, VII and VIII were all lethal. For crickets, fractions V and VI were toxic and fraction VII was lethal. In mouse, the lethal components were found in fraction VII, whereas fraction VIII was toxic, but not lethal, at the doses assayed. The molecular weight of peptides from the various group of fractions were identified by mass spectrometry determination. Components lethal to mice showed molecular weights from 7013 to 7487 Da. Two peptides were obtained in homogeneous form and shown to be lethal to the three species of animal used for assay. The soluble venom tested on L5178Y cell line survival was shown to be cytotoxic, at 10-100 µg/mL concentration, when compared to control murine splenocytes (p = 0.007). The soluble venom applied to Hela, Hutu and Jurkat cell lines did not show cytotoxic effects at these concentrations. On the contrary, it seems to have a proliferative effect. However the HPLC fractions I, III, VI and XII do have a cytotoxic effect on Jurkat E06-1 cells in culture at 200 µg/mL concentration. The antimicrobial activity of the venom fractions on Staphylococcus aureus (gram-positive), Escherichia coli, Pseudomonas aeruginosa y Salmonella spp (gram-negative) was measured, using the liquid inhibition growth system. The four strains of bacteria used were susceptible to fractions III and IV, affecting all four bacterial strains at concentrations below 5 µg/mL.

The addition of synchronous whole-body vibration to battling rope exercise increases skeletal muscle activity.

OBJECTIVES: To evaluate the effects of performing battling rope exercise with and without the addition of whole-body vibration (WBV) on muscle activity of the leg, trunk, and upper body. METHODS: Twenty-eight recreationally active university students completed 20-s of battling rope undulation for 6 separate conditions: 1) alternating arm motion no WBV -Alt_NoWBV; 2) alternating arm motion 30 Hz low amplitude WBV -Alt_30 Hz-L; 3) alternating arm motion 50 Hz high amplitude -Alt_50 Hz-H; 4) double arm motion no WBV -Double_NoWBV; 5) double arm motion 30Hz low amplitude WBV -Double_30Hz-L; 6) double arm motion 50 'Hz high amplitude -Double_50 Hz-H. Electromyography (EMG) was measured for the gastrocnemius medialis (GM), vastus medialis oblique (VMO), vastus lateralis (VL), rectus abdominis (RA), multifidus (MF), biceps brachii (BB), and triceps brachii (TB) muscles. RESULTS: The double arm motion during undulation resulted in greater (p<0.05) muscle activity in the VMO, VL, RA, and MF muscles while the GM was more active during the alternating arm motion. WBV at 50Hz increased EMG in all muscles measured vs NoWBV and the 30 Hz condition. CONCLUSION: These results are the first to demonstrate that the exercise stimulus of performing battling rope exercise can be augmented by completing the exercise while being exposed to WBV from a ground-based platform.

A comparison of different vibration exercise techniques on neuromuscular performance.

The first purpose of this study was to determine the effects of whole-body vibration (WBV) exercise during an isometric hand-grip exercise. The second purpose was to evaluate whether more than one vibratory focus would evoke an increase in the effects evoked by only one vibratory focus. The present study investigated whether WBV exposure during 10 repetitions of a handgrip dynamometer while standing on a WBV platform. Twenty-eight recreationally active university students completed 3 different test conditions, in random order: 1) grip dynamometer exercise with superimposed WBV and contralateral arm vibration (WBV+AV); 2) superimposed arm vibration only (AV); 3) grip dynamometer exercise without vibration (Control). The hand grip strength was slightly higher in the WBV condition as compared to the Control and AV conditions (1.1% and 3.6%, p>0.05, respectively). A main effect of the EMGrms of extensor digitorum muscle (ED) was observed indicating that the WBV+AV condition produced a lower co-activation of ED during a flexor digital task than the Control and AV (p<0.05) conditions. The application of WBV+AV may acutely increase muscle coordination and decreases the coactivation of ED. Furthermore, the muscle EMGrms showed increases in activation near the vibratory focus in both upper- and lower-body.

Anisakis/Ascaris IgE ratio improves specificity for the diagnosis of Anisakis simplex sensitization in travellers and immigrants.

Anisakis simplex is a fish parasite responsible for human infection and is able to induce IgE-mediated reactions with several clinical manifestations. Laboratory diagnosis of Anisakis allergy is based on the detection of specific IgE using parasite whole antigen. Unfortunately, these diagnostic tools detect cross-reactivities with other nematodes and micro-organisms leading to low specificity of the diagnostic tests. The aim of this retrospective study was to assess the diagnostic value of specific IgE to Anisakis for diagnosis of A. simplex-sensitization in native Spanish residents (IMM, n=766) and subjects coming from tropical and sub-tropical geographic areas (TRO, n=233). Since Ascaris is the human parasite most closely related to Anisakis, specific IgE to Ascaris was also determined to assess Anisakis cross-reaction with other nematodes and the diagnostic value of Anisakis/Ascaris IgE ratio for Anisakis allergy was examined. IMM and TRO groups showed similar specific IgE to Anisakis levels, while TRO had higher levels of specific IgE to Ascaris than IMM group (p=0.001). ROC curve analysis determined that an Anisakis specific IgE threshold of 0.71 kU/L yielded 93% and 82% specificities in IMM and TRO groups, respectively. A cut-off value ≥4.4 for Anisakis/Ascaris IgE ratio increased specificity to 95% for samples having IgE to Ascaris ≥0.35. In conclusion, the ratio of specific IgE to Anisakis and Ascaris improved remarkably the specificity and this parameter easily obtained from the commercially available system could be useful in the diagnosis of hypersensitivity to A. simplex.

Actitudes de los médicos de familia ante la insulinización de diabéticos tipo 2 / Family physician attitudes towards insulinization in type II diabetics

Objetivo: Determinar las actitudes de los médicos de familia del Área Sanitaria de Toledo ante el inicio de la insulinización en pacientes con diabetes mellitus tipo 2 (DM2). Material y métodos: Estudio observacional, descriptivo, transversal, mediante encuesta elaborada ad hoc con datos sociodemográficos y laborales, e inclusión de la versión española del cuestionario Diabetes Attitude Scale (DAS-3sp) para evaluar actitudes y motivaciones relacionadas con la diabetes, enviada a 353 médicos de familia del Área Sanitaria de Toledo. Resultados: Se recibieron 66 encuestas, siendo mujeres el 50,8%, con una edad media (± desviación estándar) de 49,97 ± 7,40 años. Los resultados en las diferentes subescalas (valores de 1 a 5) del DAS-3sp fueron, respectivamente: S1 (necesidad de entrenamiento especial): 4,52 ± 0,38; S2 (percepción de gravedad): 4,18 ± 0,42; S3 (valoración del control estricto): 4,15 ± 0,39; S4 (valoración del impacto psicosocial): 3,79 ± 0,48, y S5 (autonomía del paciente): 3,72 ± 0,55. No se obtuvieron diferencias estadísticamente significativas al comparar las 4 primeras subescalas con el sexo, la formación vía MIR, el ser tutor de residentes, el tipo de contrato o la ubicación de la consulta. Se encontraron diferencias en la subescala S5 por sexo (3,90 ± 0,60 en varones vs 3,54 ± 0,45 en mujeres; t = 2,701; p = 0,009) y por ser tutor de residentes (3,99 ± 0,58 frente a 3,64 ± 0,52 de los no tutores; t = 2,188; p = 0,033). Conclusiones: Entre los médicos de familia del Área Sanitaria de Toledo, las actitudes con respecto al inicio del tratamiento con insulina en pacientes con DM2 son positivas, especialmente en lo referido a los aspectos clínicos, siendo menor en los aspectos más relacionados con el impacto psicosocial en el paciente y su autonomía (AU)

Aim: To determine the attitudes of Toledo Health Area family physicians about starting insulinization in type 2 diabetic patients. Materials and methods: Descriptive, cross-sectional study. A self-completed questionnaire was given to 353 family physicians of the Toledo Health Area, asking about socio-demographic and occupational data, and including the Spanish version of the Diabetes Attitude Scale (DAS-3sp) questionnaire to evaluate attitudes and motivations related to diabetes. Results: A total of 66 responses were received, of which 50.8% were from females. Mean age (± standard deviation) was 49.97 ± 7.40. Results of the different DAS-3sp subscales (values from 1 to 5) were: S1 (need for special training): 4.52 ± 0.38; S2 (seriousness of type 2 diabetes): 4.18 ± 0.42; S3 (value of tight control): 4.15 ± 0.39; S4 (psychosocial impact of diabetes): 3.79±0.48; and S5 (need for patient autonomy): 3.72 ± 0.55. No statistically significant differences were obtained with the four first subscales with sex, specialized training, being a resident tutor, type of contract or clinical setting. There were statistically significant differences in S5 compared with sex (3.90±0,60 in men vs 3.54 ± 0.45 in women; t = 2.701; P = .009) and with being a resident tutor (3.99±0.58 vs 3.64±0.52 in non-tutors; t = 2.188; P = .033). Conclusions: The attitudes regarding starting insulin treatment in type 2 diabetic patients are positives among Toledo Health Area family physicians, specially in the clinical aspects, but they are lower in the psychosocial impact and patient autonomy (AU)

Acute unilateral leg vibration exercise improves contralateral neuromuscular performance.

OBJECTIVES: To examine the post-exercise cross-transfer effects of acute whole body vibration (WBV). METHODS: Seventeen healthy male volunteers (20.8 ± 1.2 y) performed three unilateral vibration conditions in a randomized order: 1) WBV-50 Hz [high amplitude]; 2) WBV-30 Hz [low amplitude]; and 3) a control no WBV condition (Sham) applied to the dominant leg. Each condition involved maximal voluntary isometric contractions (MVC) followed by three leg press explosive repetitions (40% MVC) with non-dominant and dominant legs; which were conducted prior to and post vibration (immediately; 2 min and 5 min). Surface electromygraphy (sEMG) of the vastus lateralis (VL) and medial gastrocnemius (MG) were measured throughout each condition. RESULTS: A condition x leg x time interaction effect was detected (p=0.001) where 50 Hz-High in the stimulated leg enhanced mean velocity at post-2 min compared to 30 Hz-Low and Sham, remaining elevated at post-5 min. Similarly, 50 Hz-High in the non-stimulated leg increased mean velocity at post-immediately and post-2 min compared to 30 Hz-Low and Sham. There were no changes in sEMG of VL and GM in the stimulated and non-stimulated post-conditions. CONCLUSION: WBV (50 Hz) can augment cross-transfer in neuromuscular performance. WBV could provide an alternate method of unilateral training to promote cross education explosive strength.

[Family physician attitudes towards insulinization in type II diabetics]. / Actitudes de los médicos de familia ante la insulinización de diabéticos tipo 2.

AIM: To determine the attitudes of Toledo Health Area family physicians about starting insulinization in type 2 diabetic patients. MATERIALS AND METHODS: Descriptive, cross-sectional study. A self-completed questionnaire was given to 353 family physicians of the Toledo Health Area, asking about socio-demographic and occupational data, and including the Spanish version of the Diabetes Attitude Scale (DAS-3sp) questionnaire to evaluate attitudes and motivations related to diabetes. RESULTS: A total of 66 responses were received, of which 50.8% were from females. Mean age (±standard deviation) was 49.97±7.40. Results of the different DAS-3sp subscales (values from 1 to 5) were: S1 (need for special training): 4.52±0.38; S2 (seriousness of type2 diabetes): 4.18±0.42; S3 (value of tight control): 4.15±0.39; S4 (psychosocial impact of diabetes): 3.79±0.48; and S5 (need for patient autonomy): 3.72±0.55. No statistically significant differences were obtained with the four first subscales with sex, specialized training, being a resident tutor, type of contract or clinical setting. There were statistically significant differences in S5 compared with sex (3.90±0,60 in men vs 3.54±0.45 in women; t=2.701; P=.009) and with being a resident tutor (3.99±0.58 vs 3.64±0.52 in non-tutors; t=2.188; P=.033). CONCLUSIONS: The attitudes regarding starting insulin treatment in type2 diabetic patients are positives among Toledo Health Area family physicians, specially in the clinical aspects, but they are lower in the psychosocial impact and patient autonomy.

Adalimumab (tumor necrosis factor-blocker) reduces the expression of glial fibrillary acidic protein immunoreactivity increased by exogenous tumor necrosis factor alpha in an organotypic culture of porcine neuroretina.

PURPOSE: To determine if exogenous addition of tumor necrosis factor alpha (TNFα) exacerbates retinal reactive gliosis in an organotypic culture of porcine neuroretina and to evaluate if concomitant adalimumab, a TNF-blocker, diminishes it. METHODS: Porcine retinal explants from 20 eyeballs were cultured. Cultures with 100 pg/ml TNFα, 10 µg/ml adalimumab, 100 pg/ml TNFα plus 10 µg/ml adalimumab, or controls without additives were maintained for 9 days. Freshly detached retinas were processed in parallel. TNFα levels in control culture supernatants were quantified with enzyme-linked immunosorbent assay. Cryostat sections were doubly immunostained for glial fibrillary acidic protein (GFAP), a marker for reactive gliosis, and cellular retinaldehyde-binding protein (CRALBP), a marker for Müller cells. Sections were also labeled with the isolectin IB4, a label for microglia/macrophages. RESULTS: TNFα in control culture supernatants was detected only at day 1. Compared to the fresh neuroretinal samples, upregulation of GFAP and downregulation of CRALBP occurred during the 9 days of culture. Exogenous TNFα stimulated glial cells to upregulate GFAP and downregulate CRALBP immunoreactivity. TNFα-treated cultures also initiated the growth of gliotic membranes and underwent retinal disorganization. Adalimumab inhibited the spontaneous increases in GFAP and maintained CRALBP. In combination with TNFα, adalimumab reduced GFAP expression and conserved CRALBP, with only slight retinal disorganization. No appreciable changes in IB4 labeling were observed under the different culture conditions. CONCLUSIONS: In cultured porcine neuroretina, spontaneous reactive gliosis and retinal disorganization were exacerbated by exogenous TNFα. Adalimumab reduced spontaneous changes and those induced by TNFα. Therefore, inhibiting TNFα may represent a novel approach to controlling retinal fibrosis observed in some human diseases.

Adenomas Ectópicos de paratiroides. Sensibilidad y Valor de las pruebas diagnósticadas para el tratamiento quirúrgico / Ectopic parathyroid adenomas. Sensitivity and value of the diagnostic tests for surgical treatment

OBJETIVOS. Presentar las peculiaridades clínico-quirúrgicas de los adenomas ectópicos de paratiroides relacionándolas con las de los adenomas normotópicos. Determinar el valor de las pruebas diagnósticas para asegurar el éxito terapéutico. MATERIAL Y MÉTODOS. Estudio prospectivo de 158 pacientes intervenidos por hiperparatiroidismo primario (1998-2010). 83% mujeres. Edad media 62,8 años±13,7. Para el diagnóstico topográfico se usaron la gammagrafía con Tecnecio-sestaMIBI, ECO y TAC (ocasional) y para asegurar la exéresis quirúrgica, la monitorización intraoperatoria de PTH y, eventualmente en los ectópicos, la cirugía radioguiada. Se seleccionaron 15 pacientes (80% mujeres) con adenomas ectópicos y se compararon con 143 adenomas ortotópicos. Se evaluaron: sexo, edad, localización, clínica, diagnóstico bioquímico y topográfico, peso glandular, vías de abordaje quirúrgico, gradientes de descenso de PTH en la monitorización y resultados postoperatorios. Para la comparación de medias se utilizó la U de Mann-Whitney y para las variables cualitativas el test de Fisher aceptando valores de p≤0,05. RESULTADOS. Fueron ectópicos el 9,5% de los adenomas. 86,7% en paratiroides inferiores (4 mediastínicas) y 13,3% en superiores. La ectopia no modificó el comportamiento clínico de los adenomas (ambas series fueron similares). La sensibilidad diagnóstica de la gammagrafía, en los ectópicos, fue 100% y para los normotópicos 80,5%. La TAC alcanzó el 66,7%, en los ectópicos, y 48,6% en los normotópicos y la Ecografía el 36,4% y 54%, respectivamente. En el grupo de adenomas ectópicos se utilizó la cervicotomía bilateral en 12 pacientes (80%), el abordaje selectivo en 3 y la sonda radioisotópica en 4. Las glándulas ectópicas extirpadas fueron adenomas. En el grupo normotópico se eligió el abordaje selectivo en el 55%. La comparación de grupos no mostró diferencias de los parámetros evaluados, salvo en la localización de los adenomas, mayor en las paratiroides inferiores (86,7% vs 68%) (p<0,05), en la sensibilidad de la gammagrafía con MIBI, también mayor (100% vs 80,5%) (p<0,001) en el grupo de los ectópicos, y en el tipo de abordaje quirúrgico CONCLUSIONES: 1. Los adenomas ectópicos constituyeron el 9,5% y fueron más frecuentes en las glándulas inferiores (86,4%). 2. No hubo diferencias clínicas entre los ectópicos y normotópicos. 3. La gammagrafía fue la prueba más sensible (100%) para detectarlos (AU)

OBJECTIVES. To present the clinical-surgical peculiarities of ectopic parathyroid adenomas, comparing them to those of the normotopic adenomas. To determine the value of the diagnostic tests in ensuring therapeutic success. MATERIAL AND METHODS. Prospective study of 158 patients operated on for primary hyperparathyroidism (1998-2010), in which 83% were women, average age 62.8 years±13.7. For the topographic diagnostic, the gammagraph was used with Tecnecio-sestamibi, ultrasound and CAT (occasional) and to ensure the surgical exeresis, the intraoperative monitoring of PTH and, possible radio-guided surgery in the ectopic adenomas. Fifteen patients were selected (80% women) with ectopic adenomas and they were compared with 143 orthotopic adenomas. The following were evaluated: Gender, age, location, clinical symptoms, biochemical diagnosis, and topography, glandular weight, channels for surgical approach, degrees of decrease of PTH in the monitoring and postoperative results. For the comparison of means, the U of Mann-Whitney was used and the Fisher test was used for the qualitative variable, accepting values of p≤0.05. RESULT. Of the adenomas, 9.5% were found to be ectopic; 86.7% in inferior parathyroids (4 mediastinal) and 13.3% in superior parathyroids. The ectopia did not change the clinical behaviour of the adenomas (both series were similar). The diagnostic sensitivity of the gammagraphy, in the ectopic adenomas, was 100% and for the normotopic 80.5%. The CAT achieved 66.7% in the ectopic and 48.6% in the normotopic; and the ultrasound achieved 36.4% and 54%, respectively. In the group of ectopic adenomas, the bilateral cervicotomy was used on 12 patients (80%), the selective approach on 3 and the radioisotopic probe on 4. The removed ectopic glands were adenomas. In the normotopic group, the selective approach was chosen in 55%. The comparison of the groups did not show differences of the evaluated parameters, except in the location of the adenomas, greater in the inferior parathyroids (86.7% vs. 68%) (p<0.05), in the sensitivity of the gammagraph with MIBI also greater (100% vs. 80.5%) (p<0.001) in the group of ectopic adenomas, and in the type of surgical approach. CONCLUSIONS: 1. The ectopic adenomas constituted 9.5%. More frequent in the inferior glands (86.4%). 2. There were no clinical differences between the ectopic and normotopic adenomas. 3. The gammagraph was the most sensitive test (100%) for detecting them (AU)

[Morbidity and costs in complete thyroidectomies. Improvement in Value of the Process by a change in the management]. / Morbilidad y costes en las tiroidectomías totales. Mejora del Valor del Proceso mediante el cambio de gestión.

OBJECTIVES: 1) To present the postoperative morbidity of complete thyroidectomies and the results of their clinical management and costs obtained after surgery. 2) To compare the results obtained for the morbidity and costs in the complete thyroidectomy Process, after the management changes introduced by the Endocrine Surgical Unit (ESU). 3) To define whether these changes improve the Value (benefit/cost ratio) of the Process. MATERIAL AND METHODS: Prospective study of cohorts conducted on 529 complete thyroidectomies performed between 1998 and 2011. We present their clinical-pathological characteristics and we compare the clinical and management results obtained after surgery in 2 time periods: 1998-2006 without ESU (group 1, 205 patients) and 2007-2011 with ESU (group 2, 324 patients). The clinical results and the possible benefits are assessed by studying the morbimortality (recurrent lesions, hypocalcaemia [<8 mg/dl], suffocative haematomas and bleeding), and those of management, for the evaluation of the use of operating room time, the average stay and the total cost of the Process. The statistical comparison study was made using Student t test, for the comparison of means and the Chi(2) to compare percentages, accepting P<.05 as significant. RESULTS: The global percentage of transient recurrent dysfunctions (TRD) was 6%, and for definitive recurrent paralysis (DRP) it was 1.5%. Hypocalcaemia, at 24 hours was 54.6%, at one month 7%, at six months 6.2% and that of definitive hypoparathyroidism 1.3%. There were 2.8% of suffocative haematomas and 2% adverse effects. The mean surgical time was 98 minutes, and the average stay was 3.66 days. In the comparison of results of the groups, the ESU improved the TRD index by nearly 7 points (10.2 vs. 3.4%, P=.002), that of DRP by 1.5 (2.4 vs. 0.4%; P=.3) until reaching under 1%. The figures on bleeding at 24 hours (53 vs. 44 cc; P=.002) and 48 hours (23 to 17 cc; P<.001), the rate of haematomas by another 6 points (6.3 vs. 0.6%; P<.001), and that of hypocalcaemia at 24 hours (P=.01). The average stay also improved (4.79 vs. 2.94 days; P<.001), the use of operating room time (reduced by 20 minutes/operation; P<.001), the total cost of the Process, decreasing by more than € 2,000/Process (P<.001), and produced a total savings for the hospital in the period of study of € 665,820. CONCLUSIONS: 1) The global results (post-operative morbidity) of our total thyroidectomies are within the quality standards. 2) The surgical specialisation and the changes introduced by the ESU improved the clinical results (greater benefit) and those of management, cutting down the average stay and the operating room usage time and decreasing costs. 3) The change in management increased the Value of the Process.

Tratamiento de las oclusiones crónicas en el sector femoropoplíteo mediante técnicas endovasculares / Treatment of chronic femoropopliteal occlusions using endovascular techniques

Introducción. El avance de las técnicas endovasculares ha proporcionado nuevas opciones en eltratamiento de lesiones complejas en el sector femopoplíteo.Objetivo. Evaluar los resultados del tratamiento endovascular en la patología oclusiva crónicadel sector femoropoplíteo.Material y métodos. Desde febrero de 1997 hasta febrero de 2009 se han incluido todas las oclusionescrónicas limitadas a la arteria femoral superfi cial y primera porción de poplítea intervenidasmediante tratamiento endovascular. Se han analizado la comorbilidad y las variables quepudieron relacionarse con reestenosis y salvación de extremidad. Las modalidades de tratamientohan sido la angioplastia simple y la angioplastia asociada a stent recubierto o norecubierto.Resultados. Durante el periodo de estudio han sido tratados 52 pacientes, con una edad mediade 71,7 años (40-94), 69,2 % varones, 53,8 % diabéticos, 69,2 % fumadores y 67,3 % hipertensos.Las lesiones tratadas (TASC II) fueron: 25 % tipo A, 46,2 % tipo B y 28,8 % tipo C. La longitud mediade la lesión fue de 73,6 mm (20-150). Hubo tres embolizaciones distales peroperatorias y cuatrooclusiones precoces. El seguimiento mediano fue de 18 meses (1-115), basado en datos clínicos,hemodinámicos y ecográfi cos. Permeabilidad primaria (3, 6, 12 y 24 meses, respectivamente):85 %, 76,8 %, 60 % y 52,5 %; primaria asistida: 85 %, 82,3 %, 74 % y 74 %; secundaria: 91,4 %, 86 %,76,4 % y 76,4 %. Ocho oclusiones tardías no pudieron ser recanalizadas, por lo que se realizóbypass (6 casos) y amputación (2 casos).Conclusiones. El tratamiento de lesiones complejas del sector femoropoplíteo, como son lasoclusiones crónicas, mediante técnicas endovasculares es una opción segura y efi caz en pacientesseleccionados(AU)

Introduction. Advances in endovascular techniques have provided new options in the treatmentof complex infrainguinal occlusive lesions.Aims. To evaluate the effectiveness and patency of endovascular treatment in patients withfemoropopliteal occlusive disease.Methods. All patients undergoing endovascular interventions for superfi cial femoral artery andabove knee popliteal artery obstructions between February 1997 and February 2009 wereretrospectively reviewed and assessed for comorbidities, operative and follow-up variablespotentially associated with restenoses and limb salvage.Results. During the study period, 52 patients were treated. Patients were 71.7 years (range40 to 94), 69.2 % male, 53.8 % diabetic, 69.2 % current or former smokers, and 67.3 % hypertensive.Lesions were 28.8 % TASC II C, 46.2 % TASC II B, and 25 % TASC II A. Mean recanalization length was73.6 mm (range 20 to 150 mm). There were three embolizations, and four early thrombosis.Mean follow-up time was 18 months (range 1 to 115), based on clinical, hemodynamic,and ultrasound data. Primary patency rates were 85 %, 76.8 %, 60 % and 52.5 % at 3, 6,12 and 24 months. Ten restenoses were successfully treated. The assisted primary patency rateswere 85 %, 82.3 %, 74 % and 74 % at 3, 6, 12 and 24 months. Eight complete occlusions could notbe reverted by a second recanalization procedure, and were treated by surgical bypass (6 cases)and amputation (2 cases). The secondary patency rates were 91.4 %, 86 %, 76.4 % and 76.4 % at 3,6, 12, and 24 months.Conclusions. Endovascular recanalization is a viable and effective strategy for lower limbrevascularization in selected patients(AU)

Utilidad del MIBI, la ecografía y la tomografía computarizada en el diagnóstico topográfico preoperatorio del hiperparatiroidismo / Utility of Methoxy Isobutyl Isonitrile (MIBI) Scintigraphy, ultrasound and computerized axial tomography in preoperative topographic diagnosis of Hiperparathyroidism

Objetivos. a) Valorar la sensibilidad de la gammagrafía con MIBI; b) comparar su resolutividad con la ecografía (ECO) y la tomografía computarizada (TC), y c) definir, a partir de su fiabilidad diagnóstica, si pueden efectuarse abordajes selectivos en el tratamiento del hiperparatiroidismo (HPT). Pacientes y método. Estudio realizado en 76 pacientes operados por HPT entre 1996 y 2005. En el diagnóstico topográfico se utilizaron la gammagrafía con 99Tc-sestamibi (MIBI) y la ECO cervical, en todos los pacientes, y la TC en 47 casos. La validación final de las pruebas, tras la visualización y la exéresis quirúrgica, se hizo por biopsias intra y postoperatoria. Resultados. La gammagrafía fue informada como positiva en 65 pacientes (85,52%). En todas las imágenes solitarias el diagnóstico fue correcto. Las imágenes múltiples se debieron a hiperplasias y adenomas paratiroideos asociados con enfermedad tiroidea (5,2%). Tres imágenes, informadas incorrectamente como negativas (3,94%), eran positivas. La sensibilidad de la ECO fue del 63% y permitió detectar 3 adenomas (4%), MIBI negativos. La TC fue menos sensible (55%), aunque descubrió otros 3 adenomas (4%), MIBI negativos. Conclusiones. a) La sensibilidad del MIBI alcanzó el 89,46%. En ausencia de nódulos tiroideos fue diagnóstica en el 100% de las lesiones únicas. Procesos patológicos tiroideos produjeron falsos positivos (5,2%) y hubo errores de interpretación (4%); b) la gammagrafía con MIBI fue más sensible que la ECO y la TC, y c) la imagen gammagráfica positiva y solitaria permite el abordaje cervical selectivo, y la ECO y la TC pueden ayudar a rescatar otro 8% de pacientes (con gammagrafía negativa) (AU)

Objectives. 1. To assess the sensitivity of scintigraphy using methoxy isobutyl isonitrile (MIBI). 2. To compare its resolution with that of ultrasound (US) and computerized axial tomography (CAT). 3. To use its diagnostic reliability to determine whether selective approaches can be used to treat hyperparathyroidism (HPT). Patients and method. A study of 76 patients who underwent surgery for HPT between 1996 and 2005 was performed. MIBI scintigraphy and cervical US were used for whole-body scanning in all patients; CAT was used in 47 patients. Intraoperative and postoperative biopsies were used for final evaluation of the tests, after visualization and surgical extirpation. Results. The results of scintigraphy were positive in 65 patients (85.52%). The diagnosis was correct in all of the single images. Multiple images were due to hyperplasia and parathyroid adenomas with thyroid disease (5.2%). Three images, incorrectly classified as negative (3.94%), were positive. The sensitivity of US was 63% and allowed detection of three MIBI-negative adenomas (4%). CAT was less sensitive (55%), but detected a further three MIBI-negative adenomas (4%). Conclusions. 1. The sensitivity of MIBI reached 89.46%. In the absence of thyroid nodules, MIBI diagnosed 100% of single lesions. Pathological thyroid processes produced false-positive results (5.2%) and there were diagnostic errors (4%). 2. MIBI scintigraphy was more sensitive than US and CAT. 3. Positive, single image scintigraphy allows a selective cervical approach. US and CAT may help to save a further 8% of patients (with negative scintigraphy)

Determinación intraoperatoria de paratirina en la cirugía del hiperparatiroidismo. Respuesta de los autores / Intraoperative parathyroid hormone determination in the surgery of hyperparathyroidism. Authors’ response

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[Intraoperative intact parathyroid hormone determination as a predictive factor of hyperparathyroidism resolution]. / La determinación peroperatoria de PTHi como factor predictivo de curación en el hiperparatiroidismo.

INTRODUCTION: The objectives of this study were: a) to evaluate the effectiveness of intraoperative intact parathyroid hormone (PTHi) determination as a marker of hyperparathyroidism resolution; b) to establish the minimum number of blood samples required; and c) to determine whether cervical manipulation increases baseline PTHi levels. PATIENTS AND METHOD: We performed a prospective study in 45 patients. Three intraoperative blood PTHi determinations were performed: at baseline and at 10 and 25 minutes after excising the lesion. To analyze the effects of cervical manipulation, in 19 patients, 2 further determinations were made after 2 minutes of massage on both sides of the neck. A decrease of > 50% in PTHi values between postexeresis samples and the baseline sample (gradient > 50%) was used as diagnostic and therapeutic criteria and normalization of calcemia was used as a criteria for complete resolution. RESULTS: Whenever the lesion causing hyperparathyroidism was extirpated, PTHi levels decreased at 10 and 25 minutes after exeresis. This decrease was predictive of complete resolution when the gradient was > 50. Cervical manipulation (massage) did not increase PTHi values. In patients with complete resolution, blood calcium levels also returned to normal. CONCLUSIONS: 1. Intraoperative PTHi determination with a gradient > 50 is an excellent prognostic marker of resolution. 2. Only 2 PTHi samples are required: one at baseline and another at 10 minutes after exeresis. 3. Preoperative cervical manipulation does not increase PTHi values.

Factores determinantes de los resultadosen la endarterectomía carotídea.Análisis del registro regional de la SociedadCentro de Angiología y Cirugía Vascular / Factors that determine the outcome in carotid endarterectomy. An analysis of the regional register of the central chapter of the Spanish Angiology and Vascular Surgery Society

Objetivo. Evaluar los factores predictores de los resultados obtenidos tras una endarterectomía (EDA) carotídea en un registro con base regional. Material y métodos. Todas las EDA carotídeas realizadas de modo consecutivo en nueve hospitales del área centro de España (1999-2000). Realización del diseño y contenido del registro por una comisión específica. Estudio de cohortes ambispectivo. Análisis estadístico: descriptivo. Coeficiente de variabilidad entre centros. Estudio uni y multivariado (regresión logística) de Material e métodos. Todas as EDA carotídeas realizadas consecutivamente em nove hospitais da área centro de Espanha (1999-2000). Realização do desenho e conteúdo do registo por uma comissão específica. Estudo de grupos ambispectivo. Resultados. Se registraron 576 intervenciones. Mortalidad global: 1,9 por ciento. Los pacientes que murieron o quedaron con secuelas discapacitantes fueron 15 (2,7 por ciento). El índice de variabilidad entre los hospitales participantes fue alto (>0,25), tanto en las técnicas utilizadas como en los resultados obtenidos. En el estudio de multivariantes, la presencia de síntomas preoperatorios (RR= indeterminado; p= 0,006) y el bajo volumen de EDA por año (RR= indeterminado; p= 0,01) se han asociado a mortalidad, y la oclusión contralateral (RR= 4,7; p= 0,02) y el uso de shunt (RR= 6,1; p= 0,01), a aparición de ictus perioperatorio. Conclusión. Ha tenido mas influencia en los resultados el perfil de riesgo del paciente que las técnicas empleadas. El bajo volumen de EDA carotídeas por año se ha visto asociado a mayor mortalidad (AU)

[Quality control in carotid surgery. Results from the carotid surgery records in Central region of Spain (1999-2000)]. / Control de calidad en cirugia carotidea. Resultados del registro de cirugia carotidea en Región Centro de España (1999-2000).

OBJECTIVE: Evaluation of technique and results of carotid endarterectomy (CEA) in the central region in Spain and possible differences among the hospitals included. Study of factors predictors of complications. PATIENTS AND METHODS: All CEAs performed in 9 hospitals in the central region in Spain (1999 2000). Registry design by a specific commission and contents selected by consensus. Voluntary participation. Ambispective study. Uni and multivariate statistical analysis (logistic regression). RESULTS: 576 procedures registered. Global mortality: 1.9%. 15 (2.7%) patients died or were severely handicapped. The selection of patients adjusted to expert s recommendations in 98%. Significant differences in technique and results were found among the hospital centres (>0,25). In the multivariate analysis, the risk factors associated with complications were: presence of preoperative symptoms (p= 0.006) small number of annual CEAs (p= 0.01), contralateral occlusion (RR= 4.7, p= 0.02) and use of shunt (RR= 6.1, p= 0.01). CONCLUSIONS: Globally, both the selection of patients and the results obtained adjust to the accepted standards for this type of surgery. The patient s risk profile has had a greater influence on the results than the technique used. The mortality rate has been influenced by the low volume hospitals

[Study of hypercholesterolemia among the child population of Valdemoro]. / Estudio de la hipercolesterolemia en la población infantil de Valdemoro.

We studied 99 children with ages ranging from 0 to 14 years, randomly selected from the census of Valdemoro (Madrid) and stratified by sex and age. The clinical records of all the children were completed and the levels of total serum cholesterol were assessed. The average cholesterol level for the total sample was 159 +/- 31 mg/dl (m +/- sd). Twenty-six children (26.3%) had values above 175 mg/dl [75th percentile of the Lipid Research Clinics Program(LRCP)], with no significant differences between the values of such percentile in both studies. Ten per cent of the children showed cholesterolemias greater than 200 mg/dl. The average cholesterol level in children whose mothers had high education levels was 125 +/- 16 mg/dl (m +/- sd), versus 161 +/- 21 mg/dl (m +/- sd); p = 0.005; (CI 95% of the difference 12 to 62 mg/dl) in children whose mothers had low-medium education levels. Cholesterol in children with family history of hypercholesterolemia (HC) showed a non-significant trend towards higher levels than in children without such antecedents (164 mg/dl vs 155 mg/dl; p = 0.19; NS). Neither the differences were significant when comparing children with or without family history of early cardiovascular disease (ECDV) (162 md/dl vs 158 md/dl; p = 0.49). Using both familiar antecedents as misleading method, just 72% of the children were diagnosed of HC (cholesterol greater than 175 md/dl). The absence of both antecedents (negative VP) would discard the presence of HC in 83% of the children in such situation (CI 95%, 67% to 92%).

El lavado quirúrgico de las manos: revisión de un método inveterado

Se realizó un estudio para evaluar el método de lavado prequirúrgico de las manos, comparando el uso o node cepillos reesterilizables, el tiempo de lavado, la clasificación de la cirugia y el tiempo operatorio. No se encontró diferencia significativa al comparar la técnica y el tiempo de lavado, anotando que con el lavado sin cepillo se obtuvo un menor crecimiento bacteriano. En conclusión, la no utilización del cepillo reesterilizado y el menor tiempo de lavado resultan en menor trauma para la piel, menor crecimiento bacteriano y considerable ahorro económico. La yodopolivinil pirrolidona en forma de espuma es un agente desinfectante eficaz cuando se utiliza para el lavado quirúrgico de las manos en las condiciones aquí descritas